Exam 2 Flashcards
Hypoglycemia
BG < 70 mg/dL
Severe <50 mg/dL
Euglycemia
BG 70-140 mg/dL normal
Hyperglycemia
Post prandial BG >140 mg/dL
Pathophysiology of glucose
Glucose: Enters blood from intestines (food consumed) Pancreas: regulates blood glucose. Secretes Insulin: LOWERS BG Secretes Glucagon: INCREASES BG Type I DM - insufficient insulin production Type II DM - Gestational (pregnancy) Medicine induced Stress or hospital-induced
Consequences of Hyperglycemia
Short-term consequences Inadequate glucose reaching the cells Dehydration Long-term consequences End-organ disease due to microvascular damage Retinopathy Nephropathy Peripheral neuropathy Macrovascular angiopathy Hypertension Cardiovascular and peripheral vascular disease
Consequences of Hypoglycemia
Irritability Fatigue Mental confusion Seizures Unconsciousness Potentially leads to cellular death
Blood Glucose: Signs & Symptoms
HYPOglycemia:
Shakiness Dizziness Sweating Hunger Irritability or moodiness Anxiety or nervousness Headache
HYPERglycemia:
Frequent urination Hunger Thirst Fruity- smelling breath Weakness Weight loss Fatigue Blurred vision Trouble concentrating Nausea & Vomiting
Risk factors for blood glucose
Risk for impaired glucose regulation Age Racial and ethnic groups Family history Lifestyle Medical risk factors Selected medications
Assessment of blood glucose regulation
Current medications Personal or family medical history markers Central obesity Diabetes Hypertension Cardiovascular disease Cancer Review of symptoms Lifestyle Factors
Primary Prevention of blood glucose regulation?
Diet, exercise, and weight control
What labs and screening are needed when caring for a patient with blood glucose issues?
Lab test - hemoglobin A1c, Point of care, and serum glucose.
Screening to detect complications - Blood pressure, Dental, foot, and eye examinations.
What would be involved with patient education?
Education:
Glucose Regulation Diabetes: The Basics Sick Day Management Nutrition Diabetic Diet Carb Counting Insulin Administration Types of Insulin Oral Agents Procedure Steps/Safety
What are the types of Insulin?
Rapid-Acting
Humalog, Novolog
Short-Acting
Humulin, Novolin
Intermediate-Acting
Humulin N, Novolin N, NPH
Long-Acting
Insulin Glargine
What are the forms of insulin delivery?
syringe, pen, pump, and inhaler
Low Blood Glucose (Hypoglycemia)
Causes, Symptoms, and Treatment
Causes: Too much insulin or diabetes pills Late/skipped meal or smaller than usual meal More activity/exercise than usual Alcohol intake without food Symptoms (happen quickly)
Symptoms: Shaky, sweaty or clammy Light-headed, weak, blurry vision Hungry, irritable, anxious or confused These are the most common symptoms. Get to know your symptoms and act quickly. If not treated quickly, you may lose consciousness.
Treatment Options
(if able to swallow)
Get treatment quickly. Take 15 grams of quick-acting carbohydrate (sugar). Examples:
4 oz. (1⁄2 cup) juice or regular (non- diet) soda
Glucose liquid or gel (read label for amount)
4 glucose tablets (chew them)
Soft, chewable candy (amount varies)
Check your blood glucose 15 minutes after treatment. If your glucose is still below 70 mg/dL, repeat treatment.
Call 911 if you feel too sick to eat or if the glucose levels stay below 80 mg/dL after 30 minutes.
High Blood Glucose (hyperglycemia)
Causes, Symptom, and Treatment options
Causes: Not enough or missed dose of insulin or diabetes pills Less activity than usual Overeating Illness (cold, flu, infection) Pain or injury Stress (physical or emotional) Some medicines (such as steroids)
Symptoms: (happen over time) Thirst, frequent urination Nausea/vomiting Unexplained weight loss Slow healing or frequent infections Fatigue or sleepy Blurred vision These are the most common symptoms. Many people do not have symptoms until glucose levels are very high, but this varies for each person. If not treated, high blood sugars can be life-threatening.
Treatment Options:
Insulin is often used to treat high blood glucose levels. If you do not use insulin, talk with your health care team about what to do. It is not always best to exercise or to eat less to lower your glucose levels. Discuss this with your health care team. If you are sick, follow sick day guidelines.
What are the nutritional requirements for adolescence
Adolescence characterized by rapid physical growth and endocrine and hormonal changes
-Caloric and protein requirements increase to meet this demand, and because of bone growth and increasing muscle mass (and, in girls, the onset of menarche), calcium and iron requirements also increase
-Increased requirements cannot be met by three meals per day; therefore, nutritious snacks play an important role in achieving adequate nutrient intake
In general, boys grow taller and have less body fat than girls
Percentage of body fat increases in females to about 25% and decreases in males (replaced by muscle mass) to about 12%
Typically, girls double their body weight between the ages of 8 and 14
Boys double their body weight between the ages of 10 and 17 years
What are food diaries
Takes time to complete, can be quite tedious
Three days, including two weekdays and one weekend day, are customarily used
Best: Record immediately after eating
Potential problems with food diary
Noncompliance
Inaccurate recording
Atypical intake on recording days
Conscious alteration of diet during recording period
Low fat and low sodium foods
Saturated & Trans Fats: Limit saturated fats to less than 10% of total calories daily by replacing them with unsaturated fats and limit trans fats to as low as possible.
Diets high in saturated and trans fats are associated with heart disease. Foods high in saturated fats include butter, whole milk, and meats that aren’t labeled lean. Trans fats are in processed foods, like desserts, frozen pizza, and coffee creamer.
Sodium: Limit to less than 2,300 mg daily (for adults and children 14 years and older).
Most Americans get 50% more sodium than recommended. Diets high in sodium are associated with high blood pressure and heart disease.
BMI calculation
Kg/m^2 = BMI
(you will NOT be given this on the test)
1ft = 0.3 meters (you will be given this conversion on the test)
Scenario: 200lbs , 6ft patient
Find Kg: 200lbs/2.2lbs = 90.9 kg
Find meters: 6ft x 0.3m = 1.8 meters
1.8 meters squared = 3.24
91/3.24m = 28.08
(for final answer, round to nearest whole #; 0.5 and over = round up)
BMI: 28
How do you inspect and auscultate during respiratory assessment?
Inspect:
Skin, color, lesions, scars
Chest shape and configuration
Effort of breathing
Auscultate:
Anterior lungs : 3L/3R spots
Posterior lungs : 3L/3R spots
Lateral Lungs : 1 spot L & R
What are adventitious lung sounds?
Crackles or Rales: Crackles are caused by the “popping open” of small airways and alveoli collapsed by fluid, exudate, or lack of aeration during expiration.
Fine: smaller airways
Coarse: larger airways
Wheeze: A wheeze is a continuous, coarse, whistling sound produced in the respiratory airways during breathing.[1] For wheezes to occur, some part of the respiratory tree must be narrowed or obstructed
Rhonchi: a snoring sound that comes from secretions within the airways
Stridor: Stridor is an abnormal, high-pitched, musical breathing sound. It is caused by a blockage in the throat or voice box (larynx). It is most often heard when taking in a breath.
How do you auscultate breath sounds?
Progress from side to side and move downward, listening for one full breath in each location.
*Note: do not place stethoscope directly over female breast; displace tissue and listen over chest wall.
What is inadequate perfusion?
Inadequate perfusion- when blood cannot transport oxygen to cells and return carbon dioxide to alveoli (decrease cardiac output, emboli, vasoconstriction)
What is reduced capacity of gas exchange?
Reduced capacity for gas transportation (reduced hemoglobin and/or red blood cells) There just aren’t enough to do the job.
What is ineffective ventilation?
Ineffective ventilation: can occur if oxygen isn’t available (high altitudes), or disorders affecting nasopharynx and lungs (spinal cord injury, rib fracture, bronchoconstriction like asthma or obstruction from things like cystic fibrosis or chronic bronchitis)
What is the consequence of severe, unresolved impairment in gas exchange?
Reduced oxygen in blood (hypoxia or absence of oxygen in blood (anoxia)
Oxygen deprived tissues
Then Cell death
S2
aortic and pulmonic valves
S1
tricuspid and mitrial
